2016 Ends on a Positive Note for Children Living with HIV

What a difference a year makes. Last December, the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (The Global Plan) was in its final days, and while there was a clear need to continue the work to end pediatric HIV and AIDS, there was also concern about how the commitment and momentum could be maintained. Turn the clock ahead to December 2016 - in just the past two weeks, there have been numerous actions taken by a wide range of political, diplomatic, technical and other stakeholders underscoring both encouraging progress made on pediatric AIDS and  the need to act with a renewed sense of urgency. 

The month started off with an announcement the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) on World AIDS Day that it is providing HIV treatment to 1.1 million children globally. PEPFAR’s announcement marked the end of its two-year Accelerating Children on Treatment (ACT) initiative, which aimed to double the number of children on treatment between 2014 and 2016. PEPFAR reported that the target was indeed met, in part due to more focused efforts in high burden geographic areas. Among the states participating in the ACT initiative, Zimbabwe performed best with 80% pediatric antiretroviral therapy (ART) coverage.

During the second week of December, a series of meetings were held in Geneva on pediatric HIV, mainly in the area of treatment. The week started with a ministerial meeting on Start Free, Stay Free, AIDS Free, the successor to the Global Plan that takes a life-cycle approach to maternal, pediatric and adolescent HIV treatment and prevention, including highly ambitious pediatric and adolescent treatment targets for 2018 and 2020. In particular, discussion on the 2018 targets - providing 1.6 million children (0-14 years) and 1.2 million adolescents (15-19) living with HIV with antiretroviral therapy by 2018 - underscored the need for urgent, targeted action by global and national partners.

At the high level event, nine ministers of health and three ambassadors voiced their enthusiasm for the new initiative and outlined specific steps they would take towards the new pediatric targets, an early and welcome sign of national ownership to add to the widespread support already provided at the global level.

Also on the diplomatic front, the UNAIDS Programme Coordinating Board (PCB) meeting held from December 7-9 dedicated several hours to the topic of pediatric HIV. Officials from UNAIDS and other partners like the World Health Organization (WHO), UNICEF and the Global Fund, diplomats from PCB Member States, and civil society delegates held a rich debate on what meaningful steps need to be taken to meet the new global targets on pediatric HIV treatment. Delegates were reminded that meeting such targets was not just a matter of respecting a political commitment, but of saving the lives of 60,000 children.

The PCB discussion centered on a new UNAIDS report on priority interventions for addressing the remaining challenges in pediatric HIV prevention and treatment. For example, the median age of initiation on treatment is 3.5 years, when 70% of untreated children will have already died. So governments and implementing partners must work harder to find undiagnosed children of all ages, and find them earlier using better techniques and looking in all the settings where children exposed to and infected with HIV may access health services. The point of care early infant diagnosis project being led by UNITAID and EGPAF is one important way to test children early, in the communities where they live, and make sure they get linked to treatment quickly. The PCB adopted a set of decision points urging countries to “take all necessary steps” to meet the new pediatric targets, to achieve the elimination of vertical HIV transmission, and calling for UNAIDS and its co-sponsors to provide progress reports to future PCB meetings.

The report presented at the PCB also noted that drug resistance and virologic failure are particularly problematic for children living with HIV, in part due to a lack of availability of optimal drugs for children. Hastening the development and uptake of child-friendly anti-retroviral (ARV) formulations has been the subject of a number of meetings in 2016, culminating with a discussion in Geneva on December 5th led by PEPFAR and WHO.  This event included dozens of experts from the public, private, and non-governmental sectors all interested in shortening the timeline between when new and better ARVs are approved for adults, and when they become available for children. They decided to advance the “Global Accelerator for Pediatric Formulations,” a set of actions to increase efficiency and expediency across the pediatric drug development spectrum. 

Several other technical meetings in Geneva – during so-called “Pediatrics Week” – also sought to improve the availability of the best possible treatment ARVs for children. From prioritizing new areas of research to strategizing in-country registration, procurement, and uptake, these meetings create an indispensable framework for ensuring children with HIV have access to the best possible treatment.

I feel energized by the unprecedented attention being given to ending vertical HIV transmission and expanding pediatric treatment. Chip Lyons, EGPAF

So as the year comes to a close, I feel energized by the unprecedented attention being given to ending vertical HIV transmission and expanding pediatric treatment. I feel confident we are at a turning point in the fight against AIDS in children. Alongside this wide group of partners, EGPAF is determined to do all it can to make sure pediatric HIV is given the urgency it deserves.